Print Form ‰ 0008 Petition for Civil No Contact Order ‰ 3601 Petition for Temporary Civil No Contact Order Petition for Civil No Contact Order (1 of 2 Pages) Clear Form (Rev. 6/15/11) CCG 0807 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS _______________________________________________________ Case No. ______________________________ Independent Proceeding ________________________________ himself/herself and/or on behalf of Criminal Proceeding ______________________________________________________ Delinquency Petition Petitioner v. ______________________________________________________ Respondent PETITION FOR CIVIL NO CONTACT ORDER Emergency Plenary (Fill in lines and check boxes as applicable) Now comes the Petitioner __________________________________________________________ on his/her own behalf or on behalf of _______________________________________________________, a minor child, or on behalf of _______________________________ ___________________________, an adult who cannot file a Petition because of age, health, disability or in accessibility on his/her own behalf, pursuant to the Civil No Contact Order Act and moves this Honorable Court to issue a Civil No Contact Order in this cause and in support thereof states as follows: ALLEGATIONS PETITIONER INFORMATION The address listed below is the Petitioner's residence. Disclosure of the Petitioner's address would risk abuse of the Petitioner or any member of the Petitioner's family; therefore, the address listed below is the Petitioner's alternative address for service of Notice and is not Petitioner's resident address. NAME ___________________________________________________________________________________________________ ADDRESS CITY _________________________________________________________________________________________________ ______________________________________ STATE _________________________________ ZIP_____________________ RESPONDENT INFORMATION NAME ___________________________________________________________________________________________________ ADDRESS _________________________________________________________________________________________________ CITY ______________________________________ STATE _________________________________ ZIP_____________________ DOB _____/_____/_____ SEX MALE DISTINGUISHING CHARACTERISTICS FEMALE RACE ______________________ HEIGHT _________ WEIGHT________ __________________________________________________________________________ RESPONDENT EMPLOYMENT INFORMATION: WORKS AT: _________________________________________________________________________________________________ ADDRESS ________________________________________________ CITY ____________ STATE ___________ ZIP ___________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Petition for Civil No Contact Order (2 of 2 Pages) (Rev. 6/15/11) CCG 0807 B PETITIONER ALLEGES AS TO RESPONDENT THAT: The following individuals are alleged to be persons who need to be protected from abuse by Respondent: ___________________________________________________________________________________________________ Respondent has committed the following acts, which constitute non-consensual/sexual conduct, or non-consensual/sexual penetration. [State details of incident(s) of abuse (including time and place), as well as effects of incident(s) on Petitioner.] ___________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Incident(s): Police report not made Police report no. _______________________ Police report made FOR EMERGENCY PETITIONS ONLY: The harm will be likely to occur if the Respondent were given any prior notice, or greater notice than was actually given, of the Petitioner's efforts to obtain judicial relief. REMEDIES REQUESTED PETITIONER REQUESTS THAT THE COURT FIND THAT THE FOLLOWING ARE PROTECTED PERSONS: ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ WHEREFORE, PETITIONER REQUESTS THE ENTRY OF A CIVIL NO CONTACT ORDER SETTING FORTH THE FOLLOWING REMEDIES: 1. The Respondent is to stay away from the Petitioner. “Stay away” means for the Respondent to refrain from both physical presence and nonphysical contact with the Petitioner whether direct, indirect (including, but not limited to, telephone calls, mail, email, faxes, and written notes), or through third parties who may or may not know about the Order of Protection. 2. The Respondent is to stay away from any other person protected under a Civil No Contact Order entered in this matter. 3. The Respondent is prohibited from physical abuse, harassment, intimidation of a dependent, interference with personal liberty, or stalking any person protected under a Civil No Contact Order entered in this matter. 4. The Respondent is prohibited from entering or remaining present at the school and/or place of employment of any person protected under a Civil No Contact Order entered in this matter. ___________________________________________________ Signature of Attorney or State's Attorney _____________________________________________ Signature of Petitioner UNDER THE PENALTIES OF PERJURY AND AS PROVIDED BY LAW PURSUANT TO SECTION 1-109 OF THE CODE OF CIVIL PROCEDURE, THE UNDERSIGNED CERTIFIES THAT THE STATEMENTS SET FORTH IN THIS INSTRUMENT ARE TRUE AND CORRECT, EXCEPT AS TO MATTERS STATED TO BE ON INFORMATION AND BELIEF AND AS TO SUCH MATTERS THE UNDERSIGNED BELIEVES THE SAME TO BE TRUE. Date _______________________________________________ _____________________________________________ Signature of Petitioner Atty. No. ___________________ Pro Se 99500 Attorney (or Pro Se Petitioner) Name:_____________________________ Address:___________________________________________________ State/City/Zip: ______________________________________________ Telephone: (__________) _____________________________________ ANY KNOWING VIOLATION OF A CIVIL NO CONTACT ORDER IS A CLASS A MISDEMEANOR. ANY SECOND OR SUBSEQUENT VIOLATION IS A CLASS 4 FELONY. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS